{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:08:31Z","timestamp":1792112911994,"version":"4.4.0"},"reference-count":14,"publisher":"Walter de Gruyter GmbH","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinicians employ two main cognitive approaches for diagnoses, depending on their expertise. Novices typically use linear hypothetico-deductive methods, while experts rely more on intuitive pattern recognition. These closely correspond to System 1 and System 2 thinking described in behavioral economics. We propose that complex cases additionally require the cognitive skill of synthesis, to visualize and understand the connections between various elements. To illustrate the concept, we describe a 60-year-old individual with a 6\u202fh history of chest pain, fever, cough, accompanying chronic heart failure, atrial fibrillation, COPD, thyrotoxicosis, and ischemic heart disease. Faced\u00a0with such a scenario, a bedside approach adapted by clinicians is to generate a list of individual diagnoses or pathways of pathogenesis, and address them individually. For example, this cluster could include: smoking causing COPD, IHD leading to chest pain and heart failure, and thyrotoxicosis causing atrial fibrillation (AF). However, other interconnections across pathways could be considered: smoking contributing to IHD; COPD exacerbating heart failure; IHD and pneumonia triggering atrial fibrillation; thyrotoxicosis and AF, independently worsening heart failure; COPD causing hypoxemia and worsening ventricular function. The second cluster of explanation offers a richer network of relationships and connections across disorders and pathways of pathogenesis. This cognitive process of creatively identifying these relationships is synthesis, described in Bloom\u2019s taxonomy of the cognitive domain. It is a crucial skill required for visualizing a comprehensive and holistic view of a patient. The concept of synthesis as a cognitive skill in clinical reasoning warrants further exploration.<\/jats:p>","DOI":"10.1515\/dx-2023-0139","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T07:09:59Z","timestamp":1706598599000},"page":"121-124","source":"Crossref","is-referenced-by-count":2,"title":["Exploring synthesis as a vital cognitive skill in complex clinical diagnosis"],"prefix":"10.1515","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9216-6988","authenticated-orcid":false,"given":"Dilushi","family":"Wijayaratne","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Medicine , University of Colombo , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2306-0885","authenticated-orcid":false,"given":"Praveen","family":"Weeratunga","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Medicine , University of Colombo , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1460-6073","authenticated-orcid":false,"given":"Saroj","family":"Jayasinghe","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Medicine , University of Colombo , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2025121206503358128_j_dx-2023-0139_ref_001","doi-asserted-by":"crossref","unstructured":"Bowen, JL. 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